Management of embolic splenic abscess secondary to aortic valve endocarditis - case report and review of literature.

BACKGROUND: Splenic abscess is a serious complication associated with infective endocarditis. There is still contradicting evidence regarding the optimal treatment pathway including timing of valve intervention and the approach for managing splenic foci. CASE PRESENTATION: We present a case of a hybrid staged approach in which we successfully performed a laparoscopic splenectomy following percutaneous abscess drainage and a delayed aortic valve replacement. CONCLUSIONS: A multidisciplinary teamwork is fundamental in providing optimal care for patients with distant complications associated with infective endocarditis. Our hybrid approach seems safe and feasible.

Splenic Abscesses in Endocarditis: A Rare Disease with High Mortality. The Experience of a Heart Institute in Brazil.

INTRODUCTION: Splenic abscess secondary to endocarditis is a rare complication with high mortality. The treatment modality, splenectomy versus percutaneous drainage, and the best time, before or after valve replacement, are controversial. In the literature, there are only a few small case series about the subject. The objective of this study is to analyze the experience of a referral center in treating such condition. METHODS: Patients with splenic abscesses due to endocarditis from 2006 to 2020 were retrospectively analyzed. RESULTS: Thirteen patients (mean age 46 years old, 69% male) were identified. Eight patients (62%) had at least 2 comorbidities and 5 (38%) had a history of cardiac surgery. The diagnosis was incidental in 6 (46%). The mean time of abscess diagnosis after endocarditis definition was 14 days. Six patients (46%) had at least two organ dysfunctions. The median APACHE II score was 12 overall, and 24.5 in patients who died. Six patients (46%) had a valve replacement, and in two the abscess was diagnosed postoperatively. Of the other four patients, splenectomy was performed before the cardiac operation in three and at the same time in one. Splenectomy was performed immediately in 9 (69%) patients while three patients had percutaneous drainage (23%), one of which underwent splenectomy due to drainage failure. Exclusive antibiotic treatment was performed on only one patient. The median length of hospitalization was 24 days and mortality was 46%. CONCLUSION: Splenic abscess due to endocarditis is a life-threatening condition with controversial treatment that results in a prolonged length of stay and high mortality.

Sarcopenia, body composition and factors associated with variceal gastrointestinal bleeding and splenectomy in hepatosplenic schistosomiasis mansoni.

BACKGROUND: Sarcopenia is a common complication of cirrhosis and an important predictor of morbimortality. We aimed to determine the prevalence of sarcopenia and its associated factors in hepatosplenic schistosomiasis (HSS) as well as to evaluate whether muscle mass and function are associated with variceal upper gastrointestinal bleeding (VUGIB) and previous splenectomy in subjects without other liver diseases. METHODS: We conducted a cross-sectional study including adults with HSS who underwent clinical, biochemical, anthropometric, muscle strength and physical performance evaluations and were submitted to bioelectrical impedance analysis and abdominal ultrasound. Sarcopenia was diagnosed according to the 2019 European consensus criteria. RESULTS: A total of 66 patients with HSS (62.1% male; mean age 48.8±8.6 y) were included. Overall, six subjects (9.1%) were diagnosed with probable sarcopenia and none had confirmed sarcopenia. Fat-free body mass index (BMI) was independently associated with VUGIB (odds ratio 0.701 [95% confidence interval 0.51 to 0.96]; p=0.025). Compared with patients who did not undergo surgery, individuals who underwent esophagogastric devascularization combined with splenectomy (EGDS) had higher serum lipid levels, fat percentage and frequency of metabolic syndrome, with lower skeletal muscle mass index and hand grip strength. CONCLUSIONS: HSS mansoni seems not to cause sarcopenia. However, a lower fat-free BMI was associated with previous VUGIB and the subgroup of patients who underwent EGDS presented higher lipid levels, fat percentage and frequency of metabolic syndrome and lower muscle mass and function.

Quiste hidático esplénico, una rara topografía de una rara enfermedad / Splenic hydatid cyst, a rare topography of a rare disease / Cisto hidatico esplénico, uma topografia rara de uma doença rara

Primary splenic hydatid cyst is a rare entity even in endemic areas. In most cases it presents asymptomatically being diagnosed by imaging findings. Treatment is multimodal and individualized, being surgical treatment the one that allows an integral solution of the disease. Conventional surgery continues to be the "Gold standard" in its approach. We present the case of a patient with this condition and the resolution approached by the surgical team.

O cisto hidatides esplénico primário é uma entidade rara mesmo em áreas endémicas. Na maioria dos casos apresenta-se de forma assintomática, sendo diagnosticada através de resultados de imagem. O tratamento é multimodal e individualizado, com um tratamento cirúrgico que proporciona uma solução abrangente para a condição. A cirurgia convencional continua a ser a abordagem "padrão de ouro". Apresentamos o caso de um paciente com esta condição e a resolução abordada pela equipa cirúrgica.

El quiste hidático primario esplénico es una entidad poco frecuente aún en áreas endémicas. Se presenta en la mayoría de los casos de forma asintomática, siendo diagnosticado por hallazgo imagenológico. El tratamiento es multimodal e individualizado, siendo el tratamiento quirúrgico el que permite una solución integral de la dolencia. La cirugía convencional sigue siendo el "Gold estándar" en su abordaje. Presentamos el caso de una paciente con esta afección y la resolución abordada por el equipo de cirugía.

Massive splenic pseudochist in pregnancy. A rare condition.

BACKGROUND: Splenic cystic lesions are rare. They are classified as type 1 with an epithelial component and type 2 (pseudocysts) without an epithelial component. Pseudocysts are the result of trauma, heart attacks, or infection. In Mexico there are no cases reported in pregnancy. CASE REPORT: 26-year-old woman, pregnant, asymptomatic. With a spleen-dependent cystic intraparenchymal lesion measuring 25 × 18 × 10 cm. Undergoing open splenectomy in the second trimester of pregnancy with satisfactory evolution. Histological analysis demonstrated a splenic pseudocyst. We describe the first case of splenic pseudocyst in a pregnant patient in Mexico.

ANTECEDENTES: Las lesiones quísticas esplénicas son infrecuentes. Se clasifican en tipo 1, con componente epitelial, y en tipo 2 (pseudoquistes), sin componente epitelial. Los pseudoquistes son resultado de traumatismos, infartos o infección. En México no existe ningún caso reportado en el embarazo. CASO CLÍNICO: Mujer de 26 años, embarazada, asintomática. Presenta una lesión intraparenquimatosa quística dependiente del bazo, de 25 × 18 × 10 cm. Es sometida a esplenectomía abierta en el segundo trimestre del embarazo, con evolución satisfactoria. El análisis histológico demostró un pseudoquiste esplénico. Describimos el primer caso de pseudoquiste esplénico en una paciente embarazada en México.

Septic shock from disseminated tuberculosis with splenic tuberculous abscess.

Splenic tuberculosis is a little-known and difficult to diagnose entity due to its low presentation of symptoms. It corresponds to one of the forms of extrapulmonary presentation of the disease, which in turn have a greater association with immunocompromised states such as diabetes mellitus. We present the case of a patient with diabetes mellitus who was admitted in the context of septic shock secondary to a probable splenic abscess, requiring surgical intervention. A total splenectomy was performed, managing to isolate Mycobacterium tuberculosis from the surgical specimen.

La tuberculosis esplénica es poco conocida y de difícil diagnóstico por su escasa presentación de síntomas. Corresponde a una de las formas de presentación extrapulmonar de la enfermedad, las cuales tienen mayor asociación con estados de inmunocompromiso, como la diabetes mellitus. Presentamos el caso de un paciente con diabetes mellitus que ingresó con choque séptico secundario a un probable absceso esplénico, requiriendo intervención quirúrgica en la que se llevó a cabo esplenectomía total y estudio histopatológico, con identificación de Mycobacterium tuberculosis en la pieza quirúrgica.

Quiste epitelial esplénico gigante, características morfológicas y evolución postoperatoria: reporte de un caso / Epithelial splenic cyst. Morphological characteristics and postoperative evolution: case report

RESUMEN: Los quistes primarios del bazo (QPB), son lesiones poco frecuentes en patología quirúrgica; los mayores de 5 cm o sintomáticos deben ser tratados quirúrgicamente para evitar el riesgo de complicaciones. Se debe realizar un examen histopatológico para confirmar el subtipo de quiste esplénico y descartar una eventual transformación maligna del revestimiento epitelial pluripotencial. El objetivo de este manuscrito fue reportar un caso de QPB intervenido quirúrgicamente y revisar la evidencia existente respecto de sus características morfológicas, terapéuticas y pronósticas. Caso clínico: Se trata de una mujer de 18 años (MAC), que consultó por distensión abdominal progresiva, de varios meses de evolución. La tomografía abdominal reveló la existencia de una masa heterogénea de 21 cm de diámetro mayor, en relación con el colon transverso y la curva mayor gástrica. El examen intraoperatorio reveló una masa sólido-quística que surgía del mesocolon transverso. La cirugía consistió en la esplenectomía y exéresis en bloque del tumor. La paciente evolucionó de forma satisfactoria, dándose de alta al quinto día del postoperatorio. El diagnóstico de quiste epitelial esplénicose estableció en base al examen patológico de la pieza quirúrgica. Cursando su 6º mes postoperatorio sin inconvenientes. Se realizó control tomográfico, que permitió verificar un bazo supernumerario funcionante.

SUMMARY: Primary splenic cysts (PSC) are rare lesions in surgical pathology; those symptomatic, or greater than 5 cm, should be treated surgically to avoid the risk of complications. A histopathological examination should be performed to confirm the splenic cyst subtype and rule out a possible malignant transformation of the pluripotential epithelial lining. The aim of this manuscript was to report a case of PSC who had undergone surgery and to review the existing evidence regarding its morphological, therapeutic and prognostic characteristics. An 18- year-old woman (MAC), consulted for progressive abdominal distention of several months of evolution. Abdominal tomography revealed the existence of a large heterogeneous mass, 21 cm in diameter, in relation to the transverse colon and the greater gastric curve. Intraoperative examination revealed a solid cystic mass arising from the transverse mesocolon. Surgery consisted of splenectomy and in-block excision of the tumor. The patient evolved satisfactorily and was discharged on the fifth postoperative day. Diagnosis of epithelial splenic cyst was established based on the pathological examination of the surgical specimen. At six months postoperative the patient had evolved satisfactorily without complications. Following abdominal tomography control a functioning supernumerary spleen was confirmed.

Hidatidosis esplénica: resultados de una serie de casos consecutiva intervenidos quirúrgicamente / Splenic hydatidosis: results of a series of consecutive cases undergoing surgery

INTRODUCCIÓN: La echinococcosis esplénica (EE), suele ser una enfermedad asintomática cuyo diagnóstico se plantea de forma incidental. OBJETIVO: Determinar morbilidad post-operatoria (MPO) y recurrencia en pacientes intervenidos quirúrgicamente por EE. Material y MÉTODO: Serie de casos con seguimiento, de pacientes con EE intervenidos de forma consecutiva, entre 2000 y 2018. Las variables resultado fueron MPO y recurrencia. Otras variables de interés fueron: diámetro y localización del quiste, tipo de cirugía, tiempo quirúrgico, estancia hospitalaria, y mortalidad. Los pacientes fueron seguidos de forma clínica y con imágenes por un mínimo de 18 meses. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión. RESULTADOS: Se intervinieron 26 pacientes (53,8% hombres), con una mediana de edad de 41,5 años. Las medianas del diámetro de los quistes, el tiempo quirúrgico y el tiempo de hospitalización fueron 14,5 cm; 65 minutos y 4,5 días, respectivamente. La MPO fue 11,5% (3 casos). No hubo mortalidad. Con una mediana de seguimiento de 94 meses, se verificó una recurrencia de 3,8%. CONCLUSIÓN: Los resultados verificados, en términos de MPO, mortalidad y recurrencia son apropiados en comparación a otras series publicadas.

BACKGROUND: Splenic echinococcosis (SE) is usually an asymptomatic disease whose diagnosis is made incidentally. Aim: To determine postoperative morbidity (POM) and recurrence in patients who underwent surgery for SE. METHODS: Case series with follow-up, of patients with SE operated on, consecutively, between 2000 and 2018. The outcome variables were POM and recurrence. Other variables of interest were diameter and location of the cyst, type of surgery, surgical time, hospital stay, and mortality. The patients were followed up clinically and with images for a minimum of 18 months. Descriptive statistics were used, with measures of central tendency and dispersion. RESULTS: Twenty-six patients (53.8% men), with a median age of 41.5 years, underwent surgery in this period. The medians of cysts diameter, surgical time and hospital stay were 14.5 cm, 65 min, and 4.5 days respectively. POM was 11.5% (3 cases). There was no mortality. With a median follow-up of 94 months, a recurrence of 3.8% was verified. CONCLUSION: Verified results, in terms of POM, mortality and recurrence are appropriate in comparison with those of series of similar size and follow-up.

Non-toxigenic Corynebacterium diphtheriae infective endocarditis with embolic events: a case report.

BACKGROUND: Corynebacterium diphtheriae (C. diphtheriae) infections, usually related to upper airways involvement, could be highly invasive. Especially in developing countries, non-toxigenic C. diphtheriae strains are now emerging as cause of invasive disease like endocarditis. The present case stands out for reinforcing the high virulence of this pathogen, demonstrated by the multiple systemic embolism and severe valve deterioration. It also emphasizes the importance of a coordinated interdisciplinary work to address all these challenges related to infectious endocarditis. CASE PRESENTATION: A 21-year-old male cocaine drug abuser presented to the emergency department with a 1-week history of fever, asthenia and dyspnea. His physical examination revealed a mitral systolic murmur, signs of acute arterial occlusion of the left lower limb, severe arterial hypotension and acute respiratory failure, with need of vasoactive drugs, orotracheal intubation/mechanical ventilation, empiric antimicrobial therapy and emergent endovascular treatment. The clinical suspicion of acute infective endocarditis was confirmed by transesophageal echocardiography, demonstrating a large vegetation on the mitral valve associated with severe valvular regurgitation. Abdominal ultrasound was normal with no hepatic, renal, or spleen abscess. Serial blood cultures and thrombus culture, obtained in the vascular procedure, identified non-toxigenic C. diphtheriae, with antibiotic therapy adjustment to monotherapy with ampicillin. Since the patient had a severe septic shock with sustained fever, despite antimicrobial therapy, urgent cardiac surgical intervention was planned. Anatomical findings were compatible with an aggressive endocarditis, requiring mitral valve replacement for a biological prosthesis. During the postoperative period, despite an initial clinical recovery and successfully weaning from mechanical ventilation, the patient presented with a recrudescent daily fever. Computed tomography of the abdomen revealed a hypoattenuating and extensive splenic lesion suggestive of abscess. After sonographically guided bridging percutaneous catheter drainage, surgical splenectomy was performed. Despite left limb revascularization, a forefoot amputation was required due to gangrene. The patient had a good clinical recovery, fulfilling 4-weeks of antimicrobial treatment. CONCLUSION: Despite the effectiveness of toxoid-based vaccines, recent global outbreaks of invasive C. diphtheriae infectious related to non-toxigenic strains have been described. These infectious could be highly invasive as demonstrated in this case. Interdisciplinary work with an institutional "endocarditis team" is essential to achieve favorable clinical outcomes in such defiant scenarios.

Effect of laparoscopic splenectomy on portal vein thrombosis and serum YKL-40 in patients with cirrhotic portal hypertension.

INTRODUCTION AND OBJECTIVES: Laparoscopic splenectomy (LS) is a supportive intervention for cirrhotic patients. However, its efficacy for patients with cirrhotic portal hypertension (CPH) still needs clarification. Studies indicated YKL-40 might be effective targets for treatment of splenomegaly, however deeper insights are unclear. The aim of this study was to investigate the effect of LS on the formation of portal vein thrombosis (PVT) and serum levels of a fibrosis marker, YKL-40, in patients with CPH. MATERIALS AND METHODS: A total of 80 patients who underwent LS and 30 healthy controls were investigated in this study. Serum levels of YKL-40 were measured by enzyme-linked immunosorbent assay (ELISA). Demographic characteristics including age and gender were recorded. Clinicopathological and laboratory examinations included the severity of esophageal varices and the presence of viral hepatitis. The liver function was assessed according to the Child-Pugh classification. The incidence of PVT before and after operation was also monitored. RESULTS: Serum YKL-40 was significantly increased in CPH patients, and was associated with Child-Pugh score and HBV infection. Furthermore, elderly patients had an increased risk for postoperative PVT. Higher serum YKL-40 was observed in patients with thrombus at postoperative 7, 14 and 21 days than those without thrombus. CONCLUSIONS: LS could reduce serum YKL-40 levels and PVT progression and was a useful treatment for patients <40 years of age with CPH.

Torção esplênica primária em cão como causa atípica de abdômen agudo / Primary splenic torsion in dog as a cause of atypical acute abdomen

Background: A primary splenic torsion occurs when the organ rotates around its vascular pedicle in the absence of any other concomitant disease. The occurrence of primary splenic torsion is rare, with a prevalence lower than 1%. Splenic torsion is more often related to dilated gastric volvulus syndrome, and it has no clear etiology despite reports that associate it with congenital abnormalities or traumatic ruptures of the gastrosplenic or splenocolic ligaments. This study reports a case of splenic torsion in an American Pit Bull terrier dog, its related symptomatology, and the treatment adopted.Case: A 3-year-old male American Pit Bull terrier dog weighing 32 kg was admitted to the hospital with symptoms of acute abdomen, lethargy, increased abdominal volume, discomfort, restlessness, and with a history of collapse three days prior to admission. Clinical examination revealed lethargy, pale mucous membranes, reduced capillary refill time, moderate dehydration, and hyperthermia. Abdominal palpation revealed increased abdominal volume in the epigastric and mesogastric areas. CBC and serum biochemistry profile revealed hypochromic normocytic anemia, leukocytosis with absolute neutrophilia and eosinopenia, mild hypoalbuminemia, and thrombocytopenia. PCR for detection of Babesia sp. and Ehrlichia sp., which returned negative results, and measurement of clotting time, which was prolonged, were performed to exclude immune-mediated hemolytic anemia. Radiographic and ultrasonographic images showed a normal stomach, but revealed presence of splenomegaly. An exploratory laparotomy allowed direct observation of the spleen, which exhibited an increased volume, a blackened, cold, hyperemic appearance, and a complete torsion of the splenic vascular pedicle; the surgical team opted to perform total splenectomy rather than undoing the pedicle twist. The animal returned to the hospital after 10 days exhibiting an excellent clinical condition.[...](AU)

Torção esplênica primária em cão como causa atípica de abdômen agudo / Primary splenic torsion in dog as a cause of atypical acute abdomen

Background: A primary splenic torsion occurs when the organ rotates around its vascular pedicle in the absence of any other concomitant disease. The occurrence of primary splenic torsion is rare, with a prevalence lower than 1%. Splenic torsion is more often related to dilated gastric volvulus syndrome, and it has no clear etiology despite reports that associate it with congenital abnormalities or traumatic ruptures of the gastrosplenic or splenocolic ligaments. This study reports a case of splenic torsion in an American Pit Bull terrier dog, its related symptomatology, and the treatment adopted.Case: A 3-year-old male American Pit Bull terrier dog weighing 32 kg was admitted to the hospital with symptoms of acute abdomen, lethargy, increased abdominal volume, discomfort, restlessness, and with a history of collapse three days prior to admission. Clinical examination revealed lethargy, pale mucous membranes, reduced capillary refill time, moderate dehydration, and hyperthermia. Abdominal palpation revealed increased abdominal volume in the epigastric and mesogastric areas. CBC and serum biochemistry profile revealed hypochromic normocytic anemia, leukocytosis with absolute neutrophilia and eosinopenia, mild hypoalbuminemia, and thrombocytopenia. PCR for detection of Babesia sp. and Ehrlichia sp., which returned negative results, and measurement of clotting time, which was prolonged, were performed to exclude immune-mediated hemolytic anemia. Radiographic and ultrasonographic images showed a normal stomach, but revealed presence of splenomegaly. An exploratory laparotomy allowed direct observation of the spleen, which exhibited an increased volume, a blackened, cold, hyperemic appearance, and a complete torsion of the splenic vascular pedicle; the surgical team opted to perform total splenectomy rather than undoing the pedicle twist. The animal returned to the hospital after 10 days exhibiting an excellent clinical condition.[...]

Esplenectomía laparoscópica por quiste hidatídico primario de bazo / Laparoscopic splenectomy by primary hydatid cyst of the spleen

Objetivo: Describir el caso clínico de un paciente con quiste esplénico hidatídico de un año de evolución resuelto por vía laparoscópica. Materiales y Métodos: Mujer de 36 años con dolor en hipocondrio izquierdo por 1 año de evolución. El estudio topográfico objetivó lesión esplénica quística de 67 mm. Se realizó esplenectomía laparoscópica sin incidentes. Resultado: Evolución posoperatoria favorable. Histología compatible con hidatidosis esplénica. Discusión: La incidencia de hidatidosis esplénica es baja, incluso en áreas endémicas, aproximándose al 1-2%. La cirugía es la estrategia terapéutica de elección dado los riesgos de ruptura, sin embargo, no hay consenso respecto a la técnica de elección. Conclusión: La esplenectomía laparoscópica es una herramienta segura y avalada en la literatura.

Objective: Describe a case report of a hydatid splenic cyst of one year of evolution, treated by laparoscopy. Materials and Methods: A 36-year-old woman with left upper quadrant pain for 1 year. The topographic study showed a 67mm splenic cystic lesion. Laparoscopic splenectomy was performed without incident. Result: Favorable post-operative evolution. Histology compatible with splenic hydatidosis. Discussion: The incidence of splenic hydatidosis is low, even in endemic areas, approaching 1-2%. Surgery is the therapeutic strategy of choice, given the risks of rupture. However, there is no consensus regarding the technique. Conclusion: Laparoscopic splenectomy is a safe procedure supported by the literature.

[Role of surgery in Saprochaete capitata (S. capitata) sepsis in a patient with acute myeloid leukemia]. / Rol de la cirugía en el manejo de la infección invasora por Saprochaete capitata.

Saprochaete capitata (S. capitata) fungal sepsis is a severe condition with a clinical presentation that is similar to other yeast originated fungal sepsis. It is observed in patients with hematological malignancies such as acute myeloid leukemia and neutropenia. We report a 23 year old male presenting with cough, fever and malaise. A bone marrow biopsy led to the diagnosis of acute myeloid leukemia. During the first cycle of chemotherapy the patient presented fever: blood cultures were positive for Klebsiella pneumoniae. Despite antimicrobial treatment, fever persisted; a computed tomography showed a focal splenic lesion; a left exudative pleural effusion appeared. A Matrix Assisted Laser Desorption Ionization-Time of Flight mass spectrometry identified the presence of S. capitata. After multiple antifungal treatments and pleural cavity cleansing by means of videothoracoscopy and laparoscopic splenectomy, the infection resolved and the patient completed his chemotherapy.

Quiste esplénico no parasitario: revisión de la experiencia en un hospital clínico universitario / Non parasitic splenic cysts: single-center experience at a university hospital

Introducción: Las lesiones quísticas esplénicas son poco frecuentes; pueden ser clasificadas en primarias y secundarias según la presencia de revestimiento epitelial. Los quistes parasitarios son provocados por especies de Equinococcus y su manejo es específico. Suelen ser lesiones asintomáticas y el tratamiento depende de su tamaño y de la aparición de manifestaciones clínicas. El abordaje quirúrgico tradicional ha sido la esplenectomía, pero con el reconocimiento de las complicaciones inmunológicas, han tenido auge las alternativas que conservan parénquima esplénico. Objetivo: Comunicar la experiencia en el manejo quirúrgico de esta enfermedad en nuestro centro. Resultados: Se presenta la serie de 11 casos de quistes esplénicos no parasitarios que recibieron tratamiento quirúrgico durante los últimos 15 años. La mayoría de las intervenciones fueron laparoscópicas y no se registró morbimortalidad. Discusión: En el tratamiento de los quistes del bazo no parasitarios actualmente se reconoce el valor de preservar parénquima y función esplénica. La esplenectomía, cirugía cuyo estándar actual es mediante laparoscopia, ha sido progresivamente desplazada por alternativas conservadoras. Las opciones terapéuticas dependen del desarrollo de síntomas, del tamaño y de la ubicación de las lesiones. Conclusiones: Los quistes esplénicos son poco frecuentes. Ante la necesidad de tratamiento quirúrgico el abordaje laparoscópico y las cirugías que conservan parénquima esplénico deberían ser de elección.

Introduction: Splenic cysts are rare. They have been classified in primary or secondary lesions based on the presence or absence of an epithelial lining. Parasitic cysts are caused by Echinococcus spp. and have a particular management. Splenic cysts are usually asymptomatic, treatment depends on the development of symptoms and diameter. Traditionally, splenectomy has been the standard surgery, but updated knowledge about the role of the spleen in preventing some infections has led to more conservative options. Objective: To report our experience in surgical management of the disease. Results: Our series includes 11 patients with non-parasitic splenic cysts treated surgically, during the last 15 years. Most were laparoscopic interventions and no morbidity or mortality was registered. Discussion: Surgical treatment for non-parasitic splenic cysts actually favours conservative techniques; salvage of the spleen whenever possible is fully justified based on updated knowledge of the role it plays in promoting protection against infection. Splenectomy, nowadays performed by laparoscopy, has been partially displaced. Treatment options depends on the cyst diameter, development of symptoms and localization. Conclusions: Splenic cysts are unfrequent. If surgical treatment is needed, laparoscopy and interventions conserving splenic parenchyma should be the election.

Rol de la cirugía en el manejo de la infección invasora por Saprochaete capitata / Role of surgery in Saprochaete capitata (S. capitata) sepsis in a patient with acute myeloid leukemia

Saprochaete capitata (S. capitata) fungal sepsis is a severe condition with a clinical presentation that is similar to other yeast originated fungal sepsis. It is observed in patients with hematological malignancies such as acute myeloid leukemia and neutropenia. We report a 23 year old male presenting with cough, fever and malaise. A bone marrow biopsy led to the diagnosis of acute myeloid leukemia. During the first cycle of chemotherapy the patient presented fever: blood cultures were positive for Klebsiella pneumoniae. Despite antimicrobial treatment, fever persisted; a computed tomography showed a focal splenic lesion; a left exudative pleural effusion appeared. A Matrix Assisted Laser Desorption Ionization-Time of Flight mass spectrometry identified the presence of S. capitata. After multiple antifungal treatments and pleural cavity cleansing by means of videothoracoscopy and laparoscopic splenectomy, the infection resolved and the patient completed his chemotherapy.

[Giant splenic cyst in a teenager girl: Case report]. / Quiste esplénico gigante en una adolescente: Caso clínico.

Giant nonparasitic splenic epidermoid cysts are relatively uncommon. These lesions can lead abdominal pain, but most of then are asymptomatic, and they are discovered incidentally. We report a 13-y old female with a giant splenic epidermoid cystic, given the special interest of diagnostic and therapeutic decision-making of this rare entity. CASE REPORT: A 13-y old female with clinical history of abdominal pain since the last two months. On physical examination a firm, tender mass was palpable in left hypochondrium. Diagnosis of a large cystic splenic mass was made based on ultrasound and abdominal computed tomography scan. Splenectomy was performed, and histopathological-immunohistochemistry studies revealed findings suggestive of primary epithelial cyst. The post-operative clinical course was satisfactory and uneventful. CONCLUSIONS: Treatment of giant nonparasitic splenic cysts is surgical. Preserve splenic parenchyma must be the aim in an individualized decision-making. The different types of surgical modalities will be according to the diagnosis and clinical situation (cyst size, age, comorbidities).

Quiste esplénico gigante en una adolescente: Caso clínico / Giant splenic cyst in a teenager girl: Case report

Los quistes esplénicos gigantes y no parasitarios son infrecuentes. Estas lesiones pueden manifestarse como dolor abdominal, si bien a menudo son asintomáticas y se diagnostican en forma incidental. Objetivo: Presentar el caso de un quiste esplénico epitelial gigante por su interés en la toma de decisiones diagnósticas y terapéuticas, al ser una entidad muy poco frecuente.
 Caso clínico: Paciente de sexo femenino de 13 años de edad que consultó por dolor abdominal de dos meses de evolución. En la exploración física se palpaba una masa de consistencia dura en hemiabdomen izquierdo. En los estudios de imágenes se visualizó una masa esplénica quística gigante. Se realizó esplenectomía obteniendo un quiste subcapsular que comprometía la mayor parte del bazo, el estudio anatomopatológico e inmunohistoquímico fueron compatible con quiste epitelial. La evolución postoperatoria y el posterior seguimiento ambulatorio fueron favorables. Conclusiones: El tratamiento de los quiste esplénicos gigantes no parasitarios es quirúrgico, intentando conservar, en lo posible, la mayor cantidad de tejido esplénico. Este procedimiento debe ser individualizado, considerando el tamaño, las posibilidades diagnósticas, el tejido esplénico residual, la edad del paciente y comorbilidades.

Giant nonparasitic splenic epidermoid cysts are relatively uncommon. These lesions can lead abdominal pain, but most of then are asymptomatic, and they are discovered incidentally. We report a 13-y old female with a giant splenic epidermoid cystic, given the special interest of diagnostic and therapeutic decision-making of this rare entity. Case report: A 13-y old female with clinical history of abdominal pain since the last two months. On physical examination a firm, tender mass was palpable in left hypochondrium. Diagnosis of a large cystic splenic mass was made based on ultrasound and abdominal computed tomography scan. Splenectomy was performed, and histopathological-immunohistochemistry studies revealed findings suggestive of primary epithelial cyst. The post-operative clinical course was satisfactory and uneventful. Conclusions: Treatment of giant nonparasitic splenic cysts is surgical. Preserve splenic parenchyma must be the aim in an individualized decision-making. The different types of surgical modalities will be according to the diagnosis and clinical situation (cyst size, age, comorbidities).